Intended for healthcare professionals

Endgames Spot Diagnosis

Renal transplant, previous breast cancer, and progressive breathlessness

BMJ 2017; 359 doi: (Published 02 November 2017) Cite this as: BMJ 2017;359:j4773
  1. Subramanian Nachiappan, radiology registrar,
  2. David C Howlett, radiology consultant
  1. Eastbourne District General Hospital, Eastbourne, UK
  1. Correspondence to S Nachiappan s.nachiappan{at}

A 68 year old woman presented with worsening shortness of breath on exertion. She had a history of polycystic kidney disease, chronic renal failure, renal transplant, and secondary hyperparathyroidism and hypercalcaemia while she was on dialysis. She had left mastectomy for breast cancer, and was on multiple medications including tacrolimus and prednisolone. Blood tests and clinical examination were unremarkable but a chest radiograph noted multiple bilateral nodular densities. Therefore a computed tomography scan was organised. What does this cross-sectional computed tomography scan (fig 1, lung window) show?

Fig 1

Axial chest computed tomography scan image

Short answer

Diffuse ill-defined centrilobular areas of rounded parenchymal lung density with associated calcifications, consistent with metastatic pulmonary calcifications. …

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